ClearCorrect is a medical device manufacturer . Treatment decisions and case diagnosis are entirely the responsibility of the prescribing doctor.

What are the main indications for auxiliaries, what are their limitations and side effects?

Auxiliaries enhance the force applied by aligners. When a tooth is not tracking with the aligner, the auxiliaries can direct pressure in the desired direction. Limitations and side effects will vary depending on the type of auxiliary and how it is applied.

How can I predict when I may need to use these systems? I would like to be able to tell a patient that these items may be used in their treatment.

Predicting the need for auxiliaries gets easier with experience. You can tell your patient that auxiliaries may be necessary when you see difficult movements such as extreme rotations, extrusions, and inter-arch corrections.

I would like to learn how to incorporate the use of auxiliaries into my cases to provide the best treatment outcomes. Do you have any recommendations?

The first step is to learn to identify difficult movements in the treatment plan. For details on how to use auxiliaries to enhance these movements, check out our article on this topic.

How does one ask for elastic cut-outs in the treatment setup?

ClearCorrect can treat class II and class III cases with elastics very effectively, but it does not support the elastic cut-outs technique. Elastic traction forces are more efficient when the elastics are attached directly to the teeth instead of hanging onto the aligners. Please refer to our article on how to extrude using auxiliaries for more information.

How do you best use pliers in a situation where a tooth is not moving as predicted?

Pliers create dimples in the aligners to nudge the teeth with a little extra pressure. They can be surprisingly effective. Before applying dimples, make sure there is adequate space on the opposing side of the aligner for the tooth to move into.

I have trouble with not being able to have elastic hooks or button cutouts in aligners. What do you recommend?

Since cutouts are not offered at this time, an alternate option is to create your own cutouts with a hole punch or coarse football diamond bur. If the patient declines this option, then you may want to explain the potential consequences of reducing the efficacy of the aligner treatment.

Are elastics used when the clear aligner fails to move the tooth or is it sometimes incorporated into the original treatment setup?

One must remember one of the basic tenets of clear aligner treatment: when a tooth is properly/fully encased in the plastic aligner material, it cannot be moved except by the forces built into the aligner.

Elastics are effectively used in conjunction with aligners in two scenarios:

Class II elastics, Class III elastics, and vertical elastics can be used with aligners to effect dental arch (skeletal) movement, not individual tooth movement. This type of elastic application should be incorporated into the initial treatment plan designed by the doctor and can be included in "Additional instructions" when submitting a case.

Elastics can be used to extrude individual teeth into occlusal gaps in the aligner caused by the teeth not moving as expected.

If the doctor desires to use Class II or Class III elastics as treatment auxiliaries, ClearCorrect recommends that the treating doctor uses elastics and buttons bonded to the teeth, since cutouts or notches in the aligner material are not offered at this time. This technique is more efficient, effective and practical for the doctor.

How often should rubber bands be changed?

A general rule of thumb is to change them every time you remove them to eat or drink.

I have difficulty adhering buttons to crowns and to the aligner as well, any suggestions?

Assure PLUS All Surface Bonding Resin from Reliance Orthodontics is great for bonding to crowns. Due to the flexibility of the aligner material, it can be difficult to keep buttons bonded to the aligner material. You may also want to consider using micro-abrasion to roughen the porcelain/aligner surface before bonding.

Can you use bite ramps on upper anteriors to help open closed bites?

ClearCorrect does not build bite ramps into its aligners. There is no credible research validating the clinical effectiveness of built-in ramps. Incisor intrusion is a more effective and predictable technique for improving deep bites.

Will bite turbos or bite ramps be offered as an option or are they unnecessary with the greater gingival coverage that ClearCorrect has in their aligners?

Doctors can request lingual engagers to prevent full closure of the teeth. This is an advanced treatment technique, and should be monitored carefully. Whether a bite turbo and/or bite ramp is necessary would be determined on a case by case basis and by the treating doctor.